As a retired health care manager I frequently argue with my husband regarding the problems and solutions to the health care mess. He is an Independent, fiscally conservative and socially liberal... currently voting Democratic because he doesn't like the wingers and thinks Bush is fiscally an idiot.

That said, he is very skeptical when I say that other countries have better health care at a lower cost! He has in his mind that the only public health care is like England and Canada, and all he has heard about those systems is bad.

So I'm really glad to see the beginnings of information on public systems that work being put out there. However, when he asks: "If France/Germany's systems work so well, why haven't we heard about it? Why aren't are business people yelling for a change?

The best answer I can come up with is that our politicians find those systems ideologically unacceptable... but that is obviously a lame answer.

Why isn't that kind of information a cover story on Time? Why isn't it known in this country that there are other options that work better? My husband is not illiterate. He reads the newspaper, he reads Time every week. (He also hears me spout stuff from the internet and will read something I print off, though he refuses to read on-line, hates the screen.)

Help me with my arguments!! He is the kind of person we need to convert to win.

Mary, you just have to be pleased that another $81 billion is going to be wasted in Iraq, while we can't cough up enough money ($1 billion) to fund AMTRAK. By God, this nation has it's prioities in line! Too bad the current administration is headed by a "C" average drunkard who has no use for science (e.g.,any of em, by god. No social sciences, no physical sciences, no logic. Nothin. Damn! If only he wouldn't have been given a free ride by his professors through college, why, he could have been living in the gutter now, instead of putting us in the gutter...or still making it by brown-nosing his dad's friends).

Bend over America! The idiot son and his wealthy minions are enjoying the hell out of this! And money to pay for this lovely $81 billion? Why, energy companies got a tax break because they are making more profits than at any other time in their history. Environmental degradation? No problem! They get a free pass and can't be prosecuted for killing people by fouling our environment. No, the money must come from our slave masters in China. You might think China would balk at this need we have for the opiate of the dollar. That's why we have to show them our hole-card and raise interest rates to entice them to ante-up. Never fear! Americans can tolerate the depressed dollar and inflation. We're a sturdy lot who don't mind being fucked-silly by the policies of this pack of morons.

Why isn't that kind of information a cover story on Time?

Well Time can't cover everything! Editorial decisions need to be made! Priority items need to be highlighted! And from this weeks cover we obviously know where Time's priorities are. ;)

JWC,

Summerize your experience with our healthcare system as it is for us.

Help me with my arguments!! He is the kind of person we need to convert to win.

Well, if the idea that over half those filing for medical bancruptcy had good health insurance, or that 43 million people don't have health care and when they get sick he pays for it through higher cost and permiums, or that we have the best health care with the worst access in the 1st world doesn't do it for him, nothing will.

Krugman starts off his column on a misstatement. He often does that, because if you accept his incorrect premise, than he can lead you through whatever political point he's trying to make. That's why I can usually stop reading his columns after the first paragraph. If he starts off his essay wrong, why bother reading the rest?

And we have lower life-expectancy and higher infant-mortality rates than countries that spend less than half as much per person.

So, he's trying to say we have lower life-expectancy because of our health care system?

Really? You buy that?

What about diet and lifestyle? We have a huge obesity epidemic in this country, that leads to heart disease, diabetes, cancer, and a host of other ills. (Link)

If this nation focused on diet and lifestyle, there wouldn't be a health care crisis, because many chronic conditions that arise from poor dietary decisions and lack of exercise could be avoided.

Take a look at the rates of Type II diabetes in some of those other countries that supposedly have "better health care systems" than the US. Geez, if hardly anybody gets sick, it sure can make your health care system look good, eh?

Solution to this nation's health crisis is as follows: Rice, veggies, and a good pair of walking shoes.

Muckdog:

Preventive Care- the poor don't get it.

What's on my mind today?

Here's a report from today's Democracy Now. It pertains to what some of us worried about all along regarding Howard Dean as an "antiwar" candidate.

Howard Dean Supports Bush on Iraq
The chair of the Democratic National Committee Howard Dean has come out in support of President Bush"s current Iraq policy. In a speech earlier this week in Minnesota, Dean said, "The president has created an enormous security problem for the United States where none existed before. But I hope the president is incredibly successful with his policy now that he's there." Dean said a US pullout could endanger the United States in three ways: By leaving a Shiite theocracy worse than that in Iran; by creating an independent Kurdistan in the north, with destabilizing effects on neighboring Kurdish regions of Turkey, Iran and Syria, and by making the so-called Sunni Triangle a magnet for what Dean called Islamic terrorists similar to the former Taliban-ruled Afghanistan. Dean was portrayed as an antiwar candidate in the media during the 2004 presidential race.

Well, I don't believe that'd reduce costs. It'd increase costs. More trips to the doctor for sniffles and scrapes. But not doing anything to reduce the cause of chronic health conditions. Where are the savings?

My main point was that regardless of socioeconomic status, most of American's chronic health conditions are self-induced. We're creating the health care crisis by choice.

What it it that George Bush likes to say?

Oh yeah!

"I believe the role of the military is to fight and win war and, therefore, prevent war from happening in the first place."

Because the cost of doing nothing is too high.

You can apply that same thought to healthcare.

I believe the role of healthcare is to fight disease and, therefore, prevent disease from happening in the first place.

Preventive war.

Preventive healthcare.

JWC,

The Journal of the American Medical Association, Dr. Barbara Starfield of the Johns Hopkins School of Medicine took a look at the overall health of the American people, and compared conditions here to those in other industrialized countries. She said:

"The fact is that the U.S. population does not have anywhere near the best health in the world," she wrote. "Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators."
She said the U.S. came in 13th, dead last, in terms of low birth weight percentages; 13th for neonatal mortality and infant mortality over all; 13th for years of potential life lost (excluding external causes); 11th for life expectancy at the age of 1 for females and 12th for males; and 10th for life expectancy at the age of 15 for females and 12th for males.

The U.S. workforce is operating at a disadvantage in the global economy. Healthcare profits create a datastrophic burden to the economic health of the U.S. public.

Why is this issued ignored?

Insurance companies, for-profit hospitals, pharmaceutical companies, and doctors-the historical linchpin of corporate medicine-oppose universal health insurance. They are powerful political players. According to Acumen Journal, "since late 1999 [U.S.] health care lobbying spending has consistently passed that of any other industry. In 2002, that amounted to expenditures of $264 million...the health care industry as a whole accounted for 15 percent of the $1.8 billion in lobbying spending for 2002."

The same pattern over and over. While the brainwashed U.S. public is distracted by stupid ideas and frivolous issues, special interest screws them and their off-springs.

After the U.S. spends more per capita on health care than any other nation in the world, the World Health Organization ranked the U.S. 37th. The U.S. and South Africa are the only two developed countries in the world that do not provide health care for all their citizens.

I sent Krugman's 1st healthcare related article to a plastic surgeon friend of mine and he said it sounded good until he got to the part about doctors' salaries. Then my friend wrote about his 90,000 dollar student loan debt(for 20 years of training), that he'll never catch up with his friends who make less but have had more years to invest money, etc. I asked if he thought that Canadian medical school was subsidized by the government since I doubted anyone would want to take on the debt and then have a lower salary. He hasn't answered, but maybe someone here might know?

Americans seem to believe that the need for health care is a moral short coming -- that being sick or hurt is invariably your own damn fault. (Of course, when they get sick, it's not *their* fault....) Muck falls into this trap and equates obesity and things that *can* be helped, at least to some extent, by your own actions with all illness. Yes, we all should take staying healthy seriously and reduce various health risks. But catching a cold or flu, having glaucoma, having osteogenesis imperfecta, polycystic kidney disease or allergies, etc. are not your fault. Some people are naturally more resistant to some things, but some people are just predisposed to some illnesses.

We also too often equate socioeconomic status and weight with moral and intellectual shortcomings...I really think we should go back to using the Victorian term "unfortunates" rather than "poor" or "bums" or whatever. It conveys the sense that many are not there by choice or fault of their own, and that the rest of us are simply *fortunate*, not superior.

The other thing that makes health care outlandishly expensive is the extreme aversion to death at any point that we all have, but Americans seem to act on more than others. I'd bet that in other countries, more people die at home, or leave the hospital at some point to die at home. We feel obligated to use the technology that we have to save people, even if they have come to terms with dying. An older woman from my congregation died this week of kidney cancer. She died at home. Some people were very distressed that she didn't want to go to the hospital or go through any treatment, but she and her family were at peace with that choice. She chose a shorter life in her home over a possibly longer life, but one that would have cost tens of thousands of dollars and put her in a foreign place to die. I hope we as a society can (in light of recent events) all come to the consensus that a longer life at all costs is not necessarily a better one.

And I hope we also realize that particularly in end-of-life care, aggressive pain management is absolutely the most powerful medical tool we have.

JWC,

Here is data that you might find useful.

JWC,

Sorry about that inoperative link. Here is the web address: www.pslgroup.com/dg448d6html.

There's no doubt that the health care system in this country is in big trouble. However, Krugman makes at least two extremely misleading assertions:
1.Public programs are much less expensive to administer than private insurance. He should sit down with a copy of the Medicare Modernization Act. Reimbursement for all programs, including public programs, is based on risk. The way the reimbursement is calculated is just as, if not more, administratively burdensome for public programs as it is for private programs. Furthermore, I guess if CMS took over all of health care reimbursement, doctors could get by with far less staff. That would be interesting....
2.All administrative expenses related to providing coverage for privately insured individuals are related to screening out high-risk clients. Apparently Mr. Krugman is not familiar with disease management programs, quality management, health and wellness services, advice nurses and the myriad other services provided by health plans to their customers. Add to that the expense associated with government regulation, which applies to private insurance as well as public.
Actually, the more I read this article, the more convinced I am that Mr. Krugman doesn't really know anything, or have anything meaningful to say on this issue. I think Kaleefornian did a much better job diagnosing the problem in his/her post.

Solution to this nation's health crisis is as follows: Rice, veggies, and a good pair of walking shoes.

muck, ain't nothing in rice, veggies or walking shoes that's going to do a damn thing for asthma. and as much as you'd like to believe that everyone would be healthy and happy if they were just like you: it ain't so. the biggest healthcare problems in this country are not self-induced, they are environmental and come from industries that aren't regulated and forced to clean up their toxic waste products. cancer isn't caused by eating fat, it's caused by eating fat that has accumualated toxins from pollution.

Ann, you're misinformed. Check the asthma and cancer info.

I have asthma, and the best thing I did for myself was lose weight when I converted to a low-fat vegan diet. In addition, most of the human population is allergic to dairy products. My allergies, once severe in the spring, disappeared once I quit dairy. I've converted several friends, who have met with similar experiences.

Try it before you dis it. You'll be surprised. Make sure you get all the lab work done before-and-after to do the comparisons. Pretty amazing.

Here's the link for the dangers of consuming milk and other dairy products.

And the link on cancer.

"Krugman starts off his column on a misstatement. He often does that, because if you accept his incorrect premise, than he can lead you through whatever political point he's trying to make."

Figure out the difference between than and then -- never a typo in my mind -- and I'll give you an ear . . . maybe.

muck, I've tried it all and I've researched it all - I worked on environmental and pure food issues for years. I've also had asthma all my life and I consume little to no dairy whatsoever. And I'm not overweight, either.

the danger with consuming dairy has little to do with it being dairy but rather the pollutants in the environment that get into the dairy. same as with meat, poultry and fish. we didn't used to see cancer like we do now, and while part of it is diagnosis, the majority of it is the pollutants that are released into the environment from industry. regulate industry. make the corporate welfare skunks pay up. they aren't going to stop polluting otherwise.

Well, Ann. I'm sure none of that stuff helps. But lets be intellectually honest, cow's milk is for baby cows.

(So that Michelle will pay attention, I really meant "calves" there. But I just like the term "baby cows.")

Disgusted,

You stated:

Krugman makes at least two extremely misleading assertions:

Paul Krugman quoted World Health Organization data. He stated:

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid.

I don't understand why you would accuse Paul of making misleading assertions when he is quoting information from a another source. Are you saying that the World Health Organization is generating misleading information?

If the World Health Organization data is wrong,

1. What is the % administrative expense for private and public health insurance respectively?
2. What is the source and basis for your information?

Disgusted, I beg to differ with you on your point #2 about screening out high risk clients.

Back in the late 80's I worked for a startup HMO briefly. While we were visiting other HMO's help set up things, I sat in on meetings with our new marketing director. The big discussion was how to train your sales people to discourage people with chronic conditions from signing up with your plan. I remember that discussion well, since I signed on with the HMO because of the idealistic idea that preventative care was the guiding principal, only to learn that the whole idea was to select healthy people. Another thing I heard in those meetings was not to sell your plan to hospital groups because statistically health care workers "used" the system and would cost you too much money.

For years in the hospital I was in charge of the Utilization Review Department and our primary goal became trying to get the HMO's to approve and pay for care. I once had an HMO tell us a patient who showed up in our ER bleeding with a miscarriage should go to her primary care physician who was 2,000 miles away! I could go on for hours with real life HMO horror stories but you get the idea.

Talk to any in the trenches health care worker and you will hear the frustration with the current system. All that our free enterprise has brought us are for-profit insurance companies who spend outrageous amounts of money and time trying to avoid paying for care. And on the other side a sometimes equal amount of money and time is spent trying to get things paid for. And in the meantime the patients have fewer nurses to take care of them and more errors are made.

Sorry MuckDog, the system is broken. And expensive. Time to try something else.

Rant over.

Thanks for the good comments and help. I actually printed off some stuff from the net today on the health care in Germany and France and had a reasonable discussion with my husband after he read them.

Oh God, Muckdog. Go eat a hamburger and stop supporting the superiority of your pseudo-lifestyle. Wait till you screw around and blow a heart valve from not eating red meat. What a dumbshit. I bet if you ever smoked and gave it up you you were a real pain in the ass on that too. My only hope is that you read the book where the guy says three high colonics a day will make you live forever.

Muckdog:

Japan reportedly has 1/2 of the infant mortality of the US- is that related to obese American babies?